22 March 2013

Many UK doctors give useless drugs, treatments

More than three-quarters of British doctors prescribe a treatment they know probably won't work at least once a week, like low-dose drugs, vitamins, nutritional supplements or an unnecessary exam, according to a new survey.

More than three-quarters of British doctors prescribe a treatment they know
probably won't work at least once a week, like low-dose drugs, vitamins,
nutritional supplements or an unnecessary exam, according to a new survey.

This use of placebo treatments directly contradicts advice from the British
Medical Association, which deems them unethical.

The researchers say the findings reveal a common practice among doctors and
should be used to change official guidance about using placebos. The surveyed
doctors said they prescribed them to induce a "placebo effect," to reassure
patients or because patients pushed for a treatment.

"For authorities to put their heads in the sand and pretend (placebo
treatments) are not being given out is not helpful," said Jeremy Howick of
Oxford University, one of the authors of the study. "We need to think of ways to
maximise the benefits of using placebos," he said.

How the survey was done

Howick and colleagues used a Web-based survey and got 783 responses. The
sample was drawn from a list that included 71% of all doctors registered with
the General Medical Council, the governing body for doctors in the UK.

The survey asked doctors if they had ever used a true placebo, like a sugar
pill or another kind of dummy treatment such as a drug not meant for the
patient's condition or a non-essential examination including blood tests and
X-rays. Nearly all of the doctors - 97% - reported having used some kind of
placebo treatment at least once, while 12% reported having used a fake pill.

About 77% of doctors said they used some kind of placebo treatment every
week; more than 80% of them said their use in some circumstances was
ethical.

The "placebo effect" treatments included unnecessary physical exams, joint
injections, physical therapy, peppermint pills for a sore throat and antibiotics
for infections where they would not be effective.

Dr Tony Calland, chairman of the British Medical Association's Ethics
Committee, said he was disappointed by the findings. "Prescribing something that
you know is of no value is not ethical," he said.

A previous study found about half of US doctors regularly give their patients
treatments that probably won't work without telling them, and the practice has
been reported elsewhere, including Canada, Denmark and Switzerland. The American
Medical Association says physicians may only use placebos if the patient is
aware.

Doctors, trust them?

In 2011, the German Medical Association recommended doctors use fake pills
and other placebo treatments more often and said patients didn't necessarily
need to be told.

Some small studies have found dummy pills work even when patients are
explicitly told what they're getting and others have documented the fake
treatments can spark a biological effect in the body.

"For illnesses where there is no truly effective treatment, a placebo or
alternative therapy is a fine thing to do," said Dr Walter Brown, a clinical
professor of psychiatry at Brown University and author of a recent book on
placebos. He was not connected to the new study.

Brown said doctors weren't obligated to use the word "placebo" when
prescribing the treatment. He said doctors should just be honest with patients
and suggested they tell them the pill has no medication in it but might still
somehow help.

Some patients found it hard to believe doctors would ever give them a placebo
treatment, including pills or an unnecessary exam, without telling them. Alex
Tellaie, who brought his son to a north London medical clinic, was doubtful his
doctor would be dishonest.

"Doctors in this country don't do that," said Tellaie, 42, a private driver.
"I trust the doctor to give my son what he needs."

Others said they would be willing to take a placebo, but only if they knew in
advance.

"I wouldn't be too happy to take something without knowing what it is and
what it might do," said Nick Christophi, a railway worker. "But if the doctor
says there's a chance that it could work, I would probably be willing to give it
a go."

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